Provider Demographics
NPI:1497134837
Name:STEPHENSON, LENZY (DO)
Entity Type:Individual
Prefix:
First Name:LENZY
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6813
Mailing Address - Country:US
Mailing Address - Phone:559-299-2608
Mailing Address - Fax:
Practice Address - Street 1:2740 HERNDON AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6813
Practice Address - Country:US
Practice Address - Phone:559-299-2608
Practice Address - Fax:559-299-1250
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79484207Q00000X
390200000X
CA16925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIDOS-2072OtherHI-MEDICAL LICENSE
GA79484OtherGA-MEDICAL LICENSE
CA20A16925OtherCA MEDICAL LICENSE
CA20A16925OtherCA MEDICAL LICENSE